NUR 256 MENTAL HEALTH FINAL EXAM QUESTIONS AND ANSWERS, UPDATED 2024/2025 GALEN COLLEGE OF NURSING

What illnesses are associated with the decrease/increase of Dopamine --CORRECT ANSWER-- decrease: Parkinson's disease, depression increase: Schizophrenia, mania What illnesses are associated with the decrease/increase of Norepinephrine -- CORRECT ANSWER-- decrease: depression increase: mania, anxiety states, schizophrenia What illnesses are associated with the decrease/increase of serotonin --CORRECT ANSWER-- decrease: depression No increases What illnesses are associated with the decrease/increase of GABA --CORRECT ANSWER-- decrease: anxiety disorders, schizophrenia, mania, and Huntington's disease Increase: reduction of anxiety What illnesses are associated with the decrease/increase of Glucamate -- CORRECT ANSWER-- decrease: psychosis increase: neurotoxic (if prolonged) neurodegeneration in Alzheimer's disease What illnesses are associated with the decrease/increase of acetylcholine -- CORRECT ANSWER-- decrease: Alzheimer's, Huntington's, Parkinson's increase: depression _____________ plays a role in learning, and memory. Stimulates ANS for "resting and digesting" --CORRECT ANSWER-- Acetylcholine _________ excitatory, AMPA plats a role in learning and memory --CORRECT ANSWER-- Glucamate NUR 256 MENTAL HEALTH FINAL EXAM QUESTIONS AND ANSWERS 2024/2025 GALEN COLLEGE OF NURSING ________ plays a role in inhibition, reduces aggression, excitation, and anxiety. may play a role in pain perception, has anticonvulsant and muscle relaxing properties. may impair cognition and psychomotor functioning --CORRECT ANSWER-- GABA ______ Plays a role in sleep regulation, hunger, mood states, pain perception, and hormonal activity. Also plays a role in aggression, and sexual behavior -- CORRECT ANSWER-- Serotonin _______ level in brain affects mood attention, and arousal. Stimulates "fight or flight" --CORRECT ANSWER-- Norepinephrine Agonist --CORRECT ANSWER-- Mimics the effects of neurotransmitters naturally found in the brain by binding to and stimulating the receptor site Antagonist --CORRECT ANSWER-- Blocks the action of the neurotransmitters, thereby obstructing the neurotransmitter's action _______ promotes the activity of GABA, possess antianxiety, hypnotic, anticonvulsant, amnestic (loss of memory), and muscle relaxant properties -- CORRECT ANSWER-- Benzodiazepines ______ Reduces anxiety without having strong hypnotic sedative effects, unlike benzos. Therefore, patients tolerate this medication better. --CORRECT ANSWER-- Buspirone (BuSpar) Buspirone affects _________, unlike benzos affecting GABA --CORRECT ANSWER-- sertonergic ________ are first line treatment options for anxiety, and anxiety related disorders. --CORRECT ANSWER-- Anti-depressants Anti-depressants require how many weeks for an anti-anxiety onset --CORRECT ANSWER-- 4-8 weeks What're anti cholinergic side effects? --CORRECT ANSWER-- Dry mouth, blurred vision, constipation, sinus tachycardia, urinary retention, and dizziness When Acetylcholine binds to receptors it has many effects: --CORRECT ANSWER-- Blurred vision, dry mouth, constipation, sinus tachycardia, urinary retention When Dopamine binds to a receptor, the effects are: --CORRECT ANSWER-- Decreased depression, psychomotor activation, anti-parkinson effect when histamine is released in the body, the following effects occur --CORRECT ANSWER-- Drowsiness, sedation, hypotension, weight gain When Serotonin is released in the body, the following effects occur: --CORRECT ANSWER-- Reduced depression, reduced suicidal behavior, anti-psychotic effects, hypotension, ejaculatory disfunction When norepinephrine is released in the body, the following effects occur: -- CORRECT ANSWER-- Reduced depression, tremors, tachycardia, ED What class does these meds belong to? Fluexotine, sertraline, parozetine, citalopram, escitalopram, and fluvoxamine -- CORRECT ANSWER-- SSRIs What would you teach your patient about SSRIs --CORRECT ANSWER-- Decreased dopamine may lead to low libido Mirtazapine (remeron) is a medication that belongs to __________ & ___________ specific class of anti-depressants --CORRECT ANSWER-- Norepinephrine and serotonin SE of Mirtazapine (remeron) --CORRECT ANSWER-- sedation, appetite stimulation, and weight gain. Bupropion (Wellbutrin) is a medication that belongs to _________ & __________ --CORRECT ANSWER-- Norepinephrine and dopamine reuptake inhibitor Bupropion (Wellbutrin) is what type of medication and often used for.... -- CORRECT ANSWER-- Anti-depressant, and smoking cessation SE of Bupropion --CORRECT ANSWER-- Insomnia, tremor, anorexia, and bulima nervousa. What class do the following medications belong to? Nefazodone, trazodone, and brexpoprazole --CORRECT ANSWER-- Serotonin antagonist reuptake inhibitors What patient teaching would you include to your patient on Serotonin antagonist reuptake inhibitors: Nefazodone, trazodone, and brezpoprazole? --CORRECT ANSWER-- Caution with life threatening liver failure, These medications are to NEVER be given with pre-existing liver conditions. What class of medications should NEVER be given to a pt with pre-existing liver conditions? --CORRECT ANSWER-- Serotonin anatgonist reuptake inhibitors What class do the following medications belong to? Venlafaxine, desvenlafaxine, and levomilndcipran? --CORRECT ANSWER-- Serotonin norepinephrine reuptake inhibitors what patient teaching should be provided when a pt is taking Serotonin norepinephrine reuptake inhibitors --CORRECT ANSWER-- monitor BP for S/S of hypertension Why're TCAs no longer considered first choice of treatment> --CORRECT ANSWER-- More SE, take longer to reach optimal therapeutic dose, and more lethal in OD. Too little serotonin causes --CORRECT ANSWER-- •Depression (Sx sleep disturbance, change in appetite, mood, motivation alterations in sexual function) •90% in the gut - GI side effects --CORRECT ANSWER-- Serotonin Too much dopamine --CORRECT ANSWER-- schizophrenia, Mania too little dopamine --CORRECT ANSWER-- Parkinson's disease •Pleasure neurotransmitter •Involved in fine motor muscle movement, emotions, thought, pleasure, motivation, Decision making --CORRECT ANSWER-- Dopamine •Affects mood, attention, arousal •Fight or Flight Response --CORRECT ANSWER-- norepinephrine Too much Norepinephrine --CORRECT ANSWER-- anxiety, schizophrenia, mania too little epinephrine --CORRECT ANSWER-- depression Too little GABA --CORRECT ANSWER-- anxiety disorders, schizophrenia, mania, Huntington's Too much GABA --CORRECT ANSWER-- reduction of anxiety Excitatory, plays a role in learning and memory --CORRECT ANSWER-- Glutamate Pharmacodynamics --CORRECT ANSWER-- what the drug does to the body Pharmacokinetics --CORRECT ANSWER-- how meds move through the body (absorption, distribution, metabolism, excretion) Pharmacogenetics --CORRECT ANSWER-- different genetics can lead to different responses to meds -Carbamazepine (tegetol) asian decent, steven johnson's syndrome •Promote GABA •Risk for abuse and dependence •Inhibit Neurons = useful as anticonvulsant •Alone - Rarely inhibit the brain to respiratory depression •Combined w/other CNS depressants (alcohol, TCAs, opiates) can lead to lifethreatening CNS depression •Interfere with motor ability, attention, judgement --CORRECT ANSWER-- Benzodiazepines •Reduces anxiety w/o strong sedative effect •No risk for addiction or dependence •Scheduled not PRN •Not a CNS depressant --CORRECT ANSWER-- buspirone •Old Tricyclic antidepressant •Insomnia - difficulty maintaining sleep •Pt with urinary retention or on MAOI should avoid •Avoid other CNS depressants and sedating meds like antihistamines --CORRECT ANSWER-- Doxepin (silenor) •Blocks orexin - suppresses wakefulness •Precautions: Daytime sleepiness, abnormal thinking and behavior changes, worsening depression and S/I, Sleep paralysis --CORRECT ANSWER-- Suvorexant (belsomra) •Blocks the reuptake of Serotonin making more available •1st line tx, less anticholinergic and sedating SE than tricyclic antidepressants (previous 1st line) •Antianxiety effects •Good efficacy lower SE profile •SE - low libido, GI upset, nausea, vomiting (90% of serotonin in gut) -- CORRECT ANSWER-- Antidepressants Selective Serotonin Reuptake Inhibitors (SSRIs) •most anticholinergic of the SSRIs class. Not for patients who are contraindicated for anticholinergics (ex: narrow angle glaucoma) --CORRECT ANSWER-- Paroxetine (paxil) •Mirtazapine (Remeron) •Antianxiety and antidepressant effects •Minimal sexual dysfunction •Improved sleep •Fewer GI SE Common SE - sedation, appetite stimulation and weight gain --CORRECT ANSWER-- Norepinephrine and Serotonin Specific Antidepressant •Bupropion (Wellbutrin) •Bupropion (Zyban) - Smoking cessation •No sexual side effects •SE - Insomnia, tremor, anorexia, weight loss •Contraindicated - Seizure disorder, bulimia or anorexia or those who are discontinuing the use of Alcohol or sedatives (benzos included) --CORRECT ANSWER-- Norepinephrine Dopamine Reuptake Inhibitor •Insufficient Acetylcholine (Neurotransmitter) •Essential for mood regulation, behavior, memory, learning •Meds - Cholinesterase Inhibitors - Cholinesterase is the enzyme that breaks down Acetylcholine --CORRECT ANSWER-- Alzheimer's Mental health --CORRECT ANSWER-- state of wellbeing, able to realize own potential, cope with normal life stressors, work productively, contribute to the community Mental illness --CORRECT ANSWER-- all psychiatric disorders that have definable diagnoses •Schizophrenia Spectrum Disorders •Depressive Disorders •Trauma and Stressor-Related Disorders Feeding and Eating Disorders --CORRECT ANSWER-- Diagnostic and statistical manual (DSM) Physiological Needs (Maslow) --CORRECT ANSWER-- Air, water, food, shelter, sleep, clothing, reproduction Safety Needs (Maslow) --CORRECT ANSWER-- Personal security, employment, resources, health, property What are risk factors and protective factors that affect the severity and progression of a mental illness, as well as the mental health of a person who does not have a mental illness? --CORRECT ANSWER-- Genetics/biological Social/economi Environmental Prenatal exposure to alcohol or oxygen deprivation. Characteristics both unborn and learned. Resilience allows effective regulation of their emotions --CORRECT ANSWER-- Genetics/biological The family sets the stage for promoting confidence and coping skills or for instilling antianxiety and feelings of inadequacy. Socioeconomic status dictates the sort of resources available to support mental health and reduce concerns over basic needs --CORRECT ANSWER-- social/economic political and cultural considerations. Those with mental illness are those who violate social norms and thus threaten those observing them --CORRECT ANSWER-- Environmental diathesis-stress model --CORRECT ANSWER-- Represents biological predisposition and stress represents environmental stress or trauma. nature vs nurture argument asserts that most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors Freud's Psychoanalytic Theory --CORRECT ANSWER-- Belief that the vast majority of mental disorders resulted from unresolved issues that originated In childhood. Theory of personality structure, levels of awareness, anxiety, the role of defense mechanisms, and the stages of psychosexual development What are Freud's levels of psychological awareness in operation? --CORRECT ANSWER-- conscious, preconscious, unconscious meaning of Conscious in Freud's level of psychological awareness --CORRECT ANSWER-- Tip of the iceberg, it contains all of the material a person is aware of at any one time including perceptions, memories, thoughts, fantasies, and feelings Meaning of preconscious is Freud's level of psychological awareness --CORRECT ANSWER-- Just below the surface of awareness, contains material that can be retrieved rather easily through conscious effort. Meaning of unconscious in Freud's psychological awareness --CORRECT ANSWER-- Includes all repressed memories, passions, and unacceptable urges lying deep below the surface, usually unable to resurface unconscious material without the assistance of a trained therapist. Freud identified three major and distinct but interactive systems of the personality. What are these three systems --CORRECT ANSWER-- ID, ego, superego Freud identified three major and distinct but interactive systems of the personality. What is the Ego? --CORRECT ANSWER-- Resides in the conscious, preconscious, and unconscious. Able to differentiate subjective experiences, memory images, and objective reality. Reality testing- factor in reality to implement a plan. Freud identified three major and distinct but interactive systems of the personality. What is the ID --CORRECT ANSWER-- Totally unconscious, impulse and drive instincts, reflexes and needs. Cannot tolerate frusteration and seek to discharge tension, inability to problem solve and is illogical ex: hungry, screaming infant Freud identified three major and distinct but interactive systems of the personality. What is the Super ego --CORRECT ANSWER-- develops between ages 3-5, represents the moral component of personality. Should and should not. When behavior falls short of the ideal, superego may induce guilt. When behavior is ideal, the superego may allow for a sense of pride. What're the five basic ethical principles important to bioethics? --CORRECT ANSWER-- Beneficence, autonomy, justice, fidelity, and veracity Beneficence --CORRECT ANSWER-- the duty to act or benefit or promote the good of others Autonomy --CORRECT ANSWER-- respecting the rights of others to make their own decisions Justice --CORRECT ANSWER-- The duty to distribute resources or care equally, regardless of personal attributes Fidelity --CORRECT ANSWER-- Maintaining loyalty and commitment to the patient and doing no wrong to the patient veracity --CORRECT ANSWER-- to duty to communicate truthfully What standards must a patient meet to be committed involuntarily? --CORRECT ANSWER-- Mentally ill, posing danger to themselves or others, gravely disabled, in need of treatment and the mental illness prevents help-seeking on a voluntary basis Confidentiality is an ethical responsibility of healthcare professionals that prohibit the disclosure of privileged information without the patient's consent. What would be an exception to the rule? --CORRECT ANSWER-- A therapist has the duty to warn a patient's potential victim of potential harm. Duty to warn is an obligation to warn third parties when they may in danger of the patient. Unintentional Tort --CORRECT ANSWER-- Unintended act against another person that produces injury, or harm. What're the five elements to prove negligence? --CORRECT ANSWER-- duty, breach of duty, cause in fact, proximate cause and damages. What're competencies for quality and safe education for nurses? --CORRECT ANSWER-- Patient centered care, quality improvement, safety, informatics, teamwork and collaboration, evidence-based practice. How should the nurse address confidentiality when dealing with adolescents -- CORRECT ANSWER-- The adolescent and their family should be provided with an overview of how information sharing will work, what information will be shared, with whom and when What are special considerations the nurse should take into consideration when assessing the older adult? PG 11 --CORRECT ANSWER-- many older adults need special attention. Be aware of physical limitations, they may be sensory, motor, or medical Advance Directives --CORRECT ANSWER-- Allow the patient to specify the type of treatment they would like for their condition Informed consent --CORRECT ANSWER-- must be obtained before a patient can receive a treatment or participate in a study/trial Tort --CORRECT ANSWER-- when one person hurts another and the injured person seeks retribution acting on questionable practice --CORRECT ANSWER-- the obligation to report suspected negligence or irresponsible behavior Milieu environments --CORRECT ANSWER-- Uses whole environment, very structured, allows participation by the patient Why may a patient not seek help for mental health? --CORRECT ANSWER-- Stigma, fear of being judged or shamed, uncomfortable sharing intimate information Mental health cycles from ________ to __________ periods --CORRECT ANSWER-- remission, exacerbation Outpatient setting --CORRECT ANSWER-- Provides preventative measures, starts with PCP; from there PCP will refer to: psychiatrists, psychologists, clinics, Inhome therapy, intensive program or partial hospitalization